Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the emergency department
Complications associated with the emergency department (ED) management of hyperkalemia are not well characterized. The goals of this study were to describe the frequency of hypoglycemia following the use of insulin to shift potassium intracellularly and to examine the association of key variables wi...
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| Veröffentlicht in: | The American journal of emergency medicine 2019-02, Vol.37 (2), p.209-213 |
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| container_title | The American journal of emergency medicine |
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| creator | Scott, Nathaniel L. Klein, Lauren R. Cales, Ellen Driver, Brian E. |
| description | Complications associated with the emergency department (ED) management of hyperkalemia are not well characterized. The goals of this study were to describe the frequency of hypoglycemia following the use of insulin to shift potassium intracellularly and to examine the association of key variables with this complication.
Adult ED patients (≥18 years old) with hyperkalemia (>5.3 mmol/L) were identified in the electronic medical record over a 5-year period at the study site. Patient characteristics, laboratory results, and treatments in the ED were captured. A generalized estimating equation (GEE) model was utilized to determine independent associations with the development of hypoglycemia.
1307 encounters were identified where hyperkalemia was present. Hypoglycemia (defined as a glucose |
| doi_str_mv | 10.1016/j.ajem.2018.05.016 |
| format | Article |
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Adult ED patients (≥18 years old) with hyperkalemia (>5.3 mmol/L) were identified in the electronic medical record over a 5-year period at the study site. Patient characteristics, laboratory results, and treatments in the ED were captured. A generalized estimating equation (GEE) model was utilized to determine independent associations with the development of hypoglycemia.
1307 encounters were identified where hyperkalemia was present. Hypoglycemia (defined as a glucose <70 mg/dL) occurred in 68/409 (17%) of patients given insulin, compared to 4% of patients who did not receive insulin. Lower glucose prior to insulin (adjusted odds ratio [aOR] 0.90; 95% confidence interval [95% CI] 0.85 to 0.96), higher doses of insulin (aOR 1.07; 95% CI 1.01 to 1.15) and lower doses of D50 (aOR 0.98; 95% CI 0.97 to 0.99) were independently associated with hypoglycemia in the multivariate analysis. Age, history of diabetes, and history renal failure were not independently associated.
Hypoglycemia is a frequent complication of treatment with IV insulin in the ED. Interventions such as standardized protocols to assist with the ED management of hyperkalemia should be developed; their efficacy and safety should be compared.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2018.05.016</identifier><identifier>PMID: 29861377</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age ; Diabetes ; Diabetes mellitus ; Diuretics ; Drug dosages ; Electronic medical records ; Emergency department ; Emergency management ; Emergency medical care ; Emergency medical services ; Family medical history ; Glucose ; Hemodialysis ; Hyperkalemia ; Hypoglycemia ; Illnesses ; Insulin ; Insulin resistance ; Intravenous administration ; Kidney diseases ; Laboratories ; Medical records ; Multivariate analysis ; Patients ; Physicians ; Potassium ; Renal failure ; Shifting ; Sodium ; Variables</subject><ispartof>The American journal of emergency medicine, 2019-02, Vol.37 (2), p.209-213</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><rights>2018. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-e8d415877b058b39c240be7995b07db248622491492e0a950a458fe737afcfba3</citedby><cites>FETCH-LOGICAL-c384t-e8d415877b058b39c240be7995b07db248622491492e0a950a458fe737afcfba3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2312578247?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994,64384,64386,64388,72240</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29861377$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scott, Nathaniel L.</creatorcontrib><creatorcontrib>Klein, Lauren R.</creatorcontrib><creatorcontrib>Cales, Ellen</creatorcontrib><creatorcontrib>Driver, Brian E.</creatorcontrib><title>Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the emergency department</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Complications associated with the emergency department (ED) management of hyperkalemia are not well characterized. The goals of this study were to describe the frequency of hypoglycemia following the use of insulin to shift potassium intracellularly and to examine the association of key variables with this complication.
Adult ED patients (≥18 years old) with hyperkalemia (>5.3 mmol/L) were identified in the electronic medical record over a 5-year period at the study site. Patient characteristics, laboratory results, and treatments in the ED were captured. A generalized estimating equation (GEE) model was utilized to determine independent associations with the development of hypoglycemia.
1307 encounters were identified where hyperkalemia was present. Hypoglycemia (defined as a glucose <70 mg/dL) occurred in 68/409 (17%) of patients given insulin, compared to 4% of patients who did not receive insulin. Lower glucose prior to insulin (adjusted odds ratio [aOR] 0.90; 95% confidence interval [95% CI] 0.85 to 0.96), higher doses of insulin (aOR 1.07; 95% CI 1.01 to 1.15) and lower doses of D50 (aOR 0.98; 95% CI 0.97 to 0.99) were independently associated with hypoglycemia in the multivariate analysis. Age, history of diabetes, and history renal failure were not independently associated.
Hypoglycemia is a frequent complication of treatment with IV insulin in the ED. Interventions such as standardized protocols to assist with the ED management of hyperkalemia should be developed; their efficacy and safety should be compared.</description><subject>Age</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diuretics</subject><subject>Drug dosages</subject><subject>Electronic medical records</subject><subject>Emergency department</subject><subject>Emergency management</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Family medical history</subject><subject>Glucose</subject><subject>Hemodialysis</subject><subject>Hyperkalemia</subject><subject>Hypoglycemia</subject><subject>Illnesses</subject><subject>Insulin</subject><subject>Insulin resistance</subject><subject>Intravenous administration</subject><subject>Kidney diseases</subject><subject>Laboratories</subject><subject>Medical records</subject><subject>Multivariate analysis</subject><subject>Patients</subject><subject>Physicians</subject><subject>Potassium</subject><subject>Renal failure</subject><subject>Shifting</subject><subject>Sodium</subject><subject>Variables</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kc1u1DAUhS1ERYfCC7BAltiwSerfsSOxQVWhSJXYlLXlODdThyQOtlMpb18PU7pg0ZWt6-8c2-cg9IGSmhK6vxxqO8BUM0J1TWRdRq_QjkrOKk0VfY12RHFZ7ZVU5-htSgMhlAop3qBz1ug95Urt0OFmW8Jh3BxM3mKbsMUuTMvonc0-zDj02M852geYw5rKPq2jn3EOOEewGd9vC8TfdvwrPx7cA4YJ4gFmt-EOFhvzBHN-h856OyZ4_7ReoF_fru-ubqrbn99_XH29rRzXIlegO0GlVqolUre8cUyQFlTTyJaormVC7xkTDRUNA2IbSayQugfFle1d31p-gT6ffJcY_qyQspl8cjCOdobyAcOIaBquy2UF_fQfOoQ1zuV1hnHKpNJMqEKxE-ViSClCb5boJxs3Q4k51mAGc6zBHGswRJoyKqKPT9ZrO0H3LPmXewG-nAAoWTx4iCY5XyKDzkdw2XTBv-T_CGk-mV0</recordid><startdate>201902</startdate><enddate>201902</enddate><creator>Scott, Nathaniel L.</creator><creator>Klein, Lauren R.</creator><creator>Cales, Ellen</creator><creator>Driver, Brian E.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201902</creationdate><title>Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the emergency department</title><author>Scott, Nathaniel L. ; Klein, Lauren R. ; Cales, Ellen ; Driver, Brian E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-e8d415877b058b39c240be7995b07db248622491492e0a950a458fe737afcfba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diuretics</topic><topic>Drug dosages</topic><topic>Electronic medical records</topic><topic>Emergency department</topic><topic>Emergency management</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Family medical history</topic><topic>Glucose</topic><topic>Hemodialysis</topic><topic>Hyperkalemia</topic><topic>Hypoglycemia</topic><topic>Illnesses</topic><topic>Insulin</topic><topic>Insulin resistance</topic><topic>Intravenous administration</topic><topic>Kidney diseases</topic><topic>Laboratories</topic><topic>Medical records</topic><topic>Multivariate analysis</topic><topic>Patients</topic><topic>Physicians</topic><topic>Potassium</topic><topic>Renal failure</topic><topic>Shifting</topic><topic>Sodium</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scott, Nathaniel L.</creatorcontrib><creatorcontrib>Klein, Lauren R.</creatorcontrib><creatorcontrib>Cales, Ellen</creatorcontrib><creatorcontrib>Driver, Brian E.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scott, Nathaniel L.</au><au>Klein, Lauren R.</au><au>Cales, Ellen</au><au>Driver, Brian E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the emergency department</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2019-02</date><risdate>2019</risdate><volume>37</volume><issue>2</issue><spage>209</spage><epage>213</epage><pages>209-213</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>Complications associated with the emergency department (ED) management of hyperkalemia are not well characterized. The goals of this study were to describe the frequency of hypoglycemia following the use of insulin to shift potassium intracellularly and to examine the association of key variables with this complication.
Adult ED patients (≥18 years old) with hyperkalemia (>5.3 mmol/L) were identified in the electronic medical record over a 5-year period at the study site. Patient characteristics, laboratory results, and treatments in the ED were captured. A generalized estimating equation (GEE) model was utilized to determine independent associations with the development of hypoglycemia.
1307 encounters were identified where hyperkalemia was present. Hypoglycemia (defined as a glucose <70 mg/dL) occurred in 68/409 (17%) of patients given insulin, compared to 4% of patients who did not receive insulin. Lower glucose prior to insulin (adjusted odds ratio [aOR] 0.90; 95% confidence interval [95% CI] 0.85 to 0.96), higher doses of insulin (aOR 1.07; 95% CI 1.01 to 1.15) and lower doses of D50 (aOR 0.98; 95% CI 0.97 to 0.99) were independently associated with hypoglycemia in the multivariate analysis. Age, history of diabetes, and history renal failure were not independently associated.
Hypoglycemia is a frequent complication of treatment with IV insulin in the ED. Interventions such as standardized protocols to assist with the ED management of hyperkalemia should be developed; their efficacy and safety should be compared.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29861377</pmid><doi>10.1016/j.ajem.2018.05.016</doi><tpages>5</tpages></addata></record> |
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| ispartof | The American journal of emergency medicine, 2019-02, Vol.37 (2), p.209-213 |
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| source | ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland |
| subjects | Age Diabetes Diabetes mellitus Diuretics Drug dosages Electronic medical records Emergency department Emergency management Emergency medical care Emergency medical services Family medical history Glucose Hemodialysis Hyperkalemia Hypoglycemia Illnesses Insulin Insulin resistance Intravenous administration Kidney diseases Laboratories Medical records Multivariate analysis Patients Physicians Potassium Renal failure Shifting Sodium Variables |
| title | Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the emergency department |
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